Borderline Personality Disorder
What is borderline personality disorder (BPD): a mental disorder that is characterized by long-term instability and dysregulation of emotions, relationships, self-image, behaviors, and thoughts. Symptoms often include intense emotional reactions, chaotic relationships, and difficulty controlling impulses. The symptoms severely interfere in functioning and cause a great deal of distress. BPD benefits from a speciality treatment called Dialectical Behavior Therapy.
The following areas of dsyregulation are commonly experienced:
| Emotions | Highly sensitive and reactive responses with difficulty returning to baseline or settling down once the emotion has been set off. |
| Relationships | Intense, chaotic and unstable relationships or absence of relationships, fears of abandonment, feelings of emptiness. |
| Self-Image | Unclear on one’s preferences, goals, and values. Difficulty sticking to one’s sense of self, having a wavering presence, a lack of self confidence. |
| Behaviors | Impulsive reactions that are often due to either difficulty regulating emotions or as an attempt to regulate the high emotion (life threatening behavior, eating, spending, addictions). |
| Thoughts | Extreme and inflexible thinking, difficulty finding a middle ground, and generating non-judgmental interpretations. |
What causes borderline personality disorder (BPD): The Biosocial Theory of BPD refers to a transaction between biology and environment that causes the overall areas of dysregulation.
- Biology: All brains and biology are different. A person with BPD is considered more emotionally vulnerable, which means increased sensitivity, intensity, and reactivity. Emotions often linger, taking longer to recover from and return to baseline following a stressor.
- Environment: When an emotionally vulnerable person also experiences an invalidating environment, BPD can develop. Invalidation can occur from anyone in the environment and may present in many different ways, such as ignoring, dismissing, minimizing, making light of problems, treating stressors as if they are due to internal character flaws, or only paying attention to distress when someone is highly emotional.
Who is affected by borderline personality disorder (BPD): 1-3% of the population experiences BPD. It is three times higher in women than men, and it is more common in psychiatric settings due to the levels of severity commonly resulting in inpatient hospitalizations. Onset can occur in adolescence and is often early adulthood. People often suffer through many therapists and treatment approaches until finding a trained professional.
Symptoms of Borderline Personality Disorder
- Mood instability
- Chaotic relationships
- Fears of abandonment with efforts to keep people around
- Impulsivity (substance abuse, eating concerns)
- Inconsistent views of oneself, easily changing based on the environment
- Life threatening urges or actions can occur
- Frequent anger, irritability, outbursts
- Emptiness
Treatment for Borderline Personality Disorder
The treatment for BPD:
- Dialectical behavior therapy is the leading treatment for borderline personality disorder.
- Other treatments include mentalization based treatment, schema focused treatment, and transference focused therapy. Wise Mind Counseling does not offer these treatments.
What is Dialectical Behavior Therapy (DBT): Comprehensive DBT is a full model program and the gold standard treatment for borderline personality disorder. It includes individual therapy (weekly or bi-weekly), skills training (weekly), phone coaching (as needed), and a consultation team for the therapist. The treatment is delivered in stages:
- Stage 1: Stablize behaviors: life threatening concerns (suicide, self-harm), therapy interfering problems (non-compliance, etc.), and quality of life problems (relationships, addictions, etc.).
- Stage 2: Treat trauma (DBT-PE)
- Stage 3: Build meaning and joy and maintain skills taught.
DBT-informed treatment means using some parts of DBT in therapy but is not the full program. This treatment is generally not for people who meet the needs of a comprehensive program, such as a BPD diagnosis that includes severely dsyregulated concerns across many areas. It is used for more mild to moderate dysregulation and when learning skills can be helpful in modulating emotions. DBT-informed treatment may include individual therapy that follows the same hierarchy of concerns as comprehensive DBT and may use a diary card. It may include skills training of some or all DBT skills. The adaptions are individually specific.
DBT skills only treatment includes teaching all DBT skills but not the other parts of DBT. The DBT skills (mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness) are helpful for anyone. Skills only as a stand alone treatment is used when individuals don’t meet the criteria for full DBT or are waiting to join a DBT program. Research has shown skills can reduce life threatening concerns and out of control behaviors.
Adapted DBT programs: Additionally there are DBT programs that offer full DBT while targeting specific concerns or diagnosis, such as DBT-SUD for substance abuse, DBT-PE for trauma, and DBT-ACES for graduates looking to build employment.
For more information:
Anxiety and Depression Association of America
National Center for PTSD via VA
DBT-PE official website
Wise Mind Counseling is highly trained and has years of experience treating BPD with DBT. DBT-informed and skills only treatments are offered. It is recommended to consult about a full, comprehensive DBT program.